Healthcare Provider Details

I. General information

NPI: 1902593999
Provider Name (Legal Business Name): SIMON KADOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W COUNTY LINE RD
JACKSON NJ
08527-2267
US

IV. Provider business mailing address

2290 W COUNTY LINE RD
JACKSON NJ
08527-2267
US

V. Phone/Fax

Practice location:
  • Phone: 732-645-9988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA13063300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: